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Fracture Repair 2 > Stabilisation of Tibial Fractures > Flashcards

Stabilisation of Tibial Fractures Flashcards

1
Q

What % of long bone fractures affect the tibia?

A

20

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2
Q

Tibial #:
A) Common cause?
B) Common location?
C) How many are open?

A

A) Trauma
B) Mid diaphyseal
C) 10-20%

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3
Q

There is often what concurrent fracture with a tibia #?
When is fixation indicated?

A
  • Fibula
    Fixation if lateral malleolus involved.
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4
Q

Tibia #:
A) Animal age?

A

Young

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5
Q

In cats, what are tibia # prone to (2) and why (2)?

A

Delayed union/non union
Due to: Minimal soft tissue envelope and limited vascular supply

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6
Q

What muscles attach to the tibia? (4)

A

Quadriceps femoris
Biceps femoris
Caudal part of the sartorius
Cranial tibial

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7
Q

Shape of the proximal tibia?

A

Flat+triangle

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8
Q

Shape of distal tibia?

A

Half cylindrical

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9
Q

Blood supply to the tibia:
A) (2)
B) What are these derived from?

A

A) Nutrient a. + Periosteal vessels
B) Cranial tibial a.

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10
Q

Where is the nutrient foramen on the tibia?

A

Caudolateral edge of proximal 1/3 of the diaphysis

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11
Q

Tibia #:
What will help sustain medullary arterial supply when the principal nutrient artery is disrupted by fracture or surgery?

A

Anastomoses with metaphyseal arteries

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12
Q

Where does the Cranial branch of median saphenous artery and vein and saphenous nerve pass across on the tibia?

A

Diaphysis

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13
Q

Tibia #:
What are the pre treatment surgical planning things to consider (4)

A
  1. List all possible stabilisation options e.g., external coaptation, IM pin, IN, plate and screw, ESF.
  2. Rule outs e.g., no external coaptation for upper limb bones, no IM pin for radial fractures.
  3. Compare and contrast the choices e.g., costs, likelihood of complications, experience of surgeon.
  4. Decide on the best option (or an A, B, C list).
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14
Q

Why are distal diaphysis # of the tibia often open?

A

Minimal soft tissue coverage

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15
Q

CARE when palpating distal diaphysis # - why?

A

Do not create an open #

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16
Q

What needs to be done to an open tibia # whilst awaiting reapir?

A

External coaptation with a splint or modified Robert Jones bandage indicated to prevent additional injury

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17
Q

Xray positions for tibia #?

A

Medio-Lateral
CrCd (or CdCr)

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18
Q

Tibial diaphyseal fractures can be of what pattern? (7)

A
  • Mostly mid-diaphyseal
  • Incomplete
  • Transverse
  • Oblique
  • Spiral
  • Comminuted
  • Segmental.
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19
Q

Most common # type of tibia diaphyseal #? (3)

A
  • Oblique
  • Spiral
  • comminuted
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20
Q

Advantages of using bone plates for the stabilisation of tibial diaphyseal fractures?

A

Plates can be used for repair of almost all types of fractures of the tibial diaphysis

Very versatile

Easy approach to the tension band side of the bone (medial tibia) with minimal soft tissue dissection

Well tolerated by animals postoperatively.

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21
Q

Tension side of the tibia?

A

Medial

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22
Q

Which side of the tibia are plates normally applied?

A

Medial

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23
Q

Medial approach to the tibia:
A) Patient positioning?

A

Dorsal recumbency with the affected hindlimb suspended for draping.

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24
Q

Where is the incision made for a medial approach to the tibia?

A

Proximally over the medial tibial condyle, curve cranially to the midline of the tibia at midshaft and curve caudally to end near the medial malleolus.

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25
Q

What is ideally (not essentially preserved) on the medial approach to the tibia which runs across it? (2)

A

Saphenous vessels + nerve

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26
Q

Medial approach to the tibia, complete these sentences:
A) Incise the fascia along the borders of the ? (2) and retract the muscles to expose the bone.
B) Incise the crural fascia along the cranial border of the cranial tibial muscle from the ? to the ? of the muscle to expose the lateral cortex.

A

A) cranial tibial and medial digital flexor muscle
B) tibial tuberosity to tendinous portion

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27
Q

What retracted on the medial approach to the tibia to expose the shaft? (+ direction)

A

Retract the cranial tibial and long digital extensor muscles caudolaterally

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28
Q

When using hohmann retractors to expose tibia shaft - care not to damage what..?

A

Cranial tibial a

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29
Q

How to gain exposure to distal lateral region of the tibia through the medial approach?

A

Incising the fascia lateral to the tendons of the cranial tibial and long digital extensor muscles and retract the tendons cranially.

30
Q

A plate applied to create ? at the fracture site can be applied for simple transverse fractures

A

Compression

31
Q

A ? plate with screws applied in lag fashion through the plate can be used for oblique/spiral fractures and for some reducible comminuted fractures.

A

Neutralisation

32
Q

A ? plate can be used for nonreducible comminuted fractures.

A

Bridging

33
Q

What combincation is an effective fixation method for nonreducible comminuted fractures. This technique may be applied using a limited open surgical approach?

A

plate-rod combination

34
Q

Minimally invasive plate osteosynthesis can be applied to the tibia, what incision does this involve?

A

small, medially located skin incision over the proximal and distal aspects of the tibia

35
Q

Minimally invasive plate osteosynthesis of the tibia; following initial incision what are the next steps?

A

A soft tissue tunnel is created between the periosteal surface of the tibia and the overlying muscular fascia connecting the two incisions. A plate, preferably a locking plate is then slid along the surface of the tibia, and screws are applied through the proximal and distal incisions.

36
Q

T or f
There is no documented difference in healing times between minimally invasive plate osteosynthesis and open plating.

A

True

37
Q

For non-locking plates and hybrid fixations (using non-locking and locking screws), what of the plate is required to closely fit the curvature of the medial cortex.

A

contouring including some twisting

38
Q

For complex fractures in particular affecting the distal third of the tibia what technique has become an additional technique to promote bone healing while providing adequate stability.

A

of orthogonal plating

39
Q

Where are plates placed for orthogonal plating?

A

smaller plate is applied in addition to a medially applied plate.

40
Q

What are locking plated used for orthogonal plating commonly made of?

A

Titanium

41
Q

How long is strict exercise after repair for?

A

6 weeks and gradually increase

42
Q

When are post op xrays performed after repair in mature animals?

A

6-8wks

43
Q

When are post op xrays perfromed post repair in immature animals?

A

4-6wks

44
Q

Prognosis for tibia # following repair

A

Good

45
Q

This long oblique mid diaphyseal fracture in a 5-year-old Rottweiler

How to repair?

A

4 lag screws applied through the plate (3.5mm DCP). The plate acts as a neutralisation plate.

46
Q

ibia of a 3-year-old Bernese Mountain Dog
comminuted mid-diaphyseal tibial fracture - how to repair?

A

plate-rod construct, using a 3.5mm broad LCP in bridging mode and hybrid fashion, using locking screws for all but the two most distal screws, which are non-locking screws to allow angulation away from the talocrural join

47
Q

Which animals is a tibial tuberosity avulsion common in?

A

Immature
4-8 mo

48
Q

Where does the tibial tuberosity fuse as an animal reaches skeletal maturity? (2)

A
  • Proxiaml epiphysis
    Tibia metaphyssis
49
Q

What muscle does a tibial avulsion pull on?

A

Quadriceps femoris

50
Q

What breed are over respresented with tibial avulsion?

A

Terrier

51
Q

Clinical signs of tibial avulsion? (4)

A
  • Lame
  • Pain
  • Joint effusion of the stifle
  • Soft tissue swelling
52
Q

Why take xrays of other limb with tibial avulsion?

A

Compare

53
Q

What needs to be considered when thinking of treatment option for a tibial avulsion? (3)

A
  • Degree of displacement
  • Size of animal
  • Remaining growth potential
54
Q

Treating tibial avulsion, what is involved with conservative tx (1)and where is this appropriate? (2)

A
  • External coaptation
  • Small breed dog
    *minimal displacement
55
Q

How to reduce a displaced tibial tuberosity?

A

By carefully pulling the tuberosity back into position with the hip flexed and the stifle joint extended. Note: Care should be taken not to fracture the tibial tuberosity when placing bone holding forceps.

56
Q

How to surgical fix a tibial avulsion following reduction?

A

Fixation is achieved by using two Kirschner wires and a tension band wire.

57
Q

When to remove the fixation when avulsion is healed to avoid premature fusion and distal translocation of the tuberosity?

A

Large/medium breed - <6mo
Small breed <4mo

58
Q

Prognosis for normal function following surgical repair of tibial avulsion??

A

Prognosis

59
Q

What defects are common followign sx management of tibial avulsion? (2)

A
  • Premature closure of the apophyseal growth plate
  • Deformity of the tibial tuberosity are common
60
Q

Common fractures of the proximal physis of the tibia:
A) Which salter harris? (2)
B) what combination of #?

A

A) type I or II fractures.
B) Combined fractures of the proximal epiphysis and tibial tuberosity with cranio-medial displacement of the tibial metaphysis/diaphysis.

61
Q

Common fractures of the distal physis of the tibia:
A) Which salter harris?

A

Type I or II

62
Q

Occassional Fractures of the distal physis of the tibia can have closed reduction with what forces? (3) What is used in v young animals?

A

A) traction, countertraction, and manipulation of the limb.
If the fracture is stable after reduction, a full cast or a lateral splint it is possible to be used, in very young animals.

63
Q

How are # of the distal physis of the tibia often reduced + what is the approach?

A

Open reduction
- Medial approach

64
Q

Fractures of the distal physis of the tibia:
A) How to openly reduce #?
B) How is fixation achieved?

A

A) Reduce the fracture by gently levering the epiphysis onto the metaphysis.

B) The fixation is achieved with cross-pinning using two K-wires inserted diagonally.

65
Q

Fractures of the distal physis of the tibia:
Where is the insertion started? crosses? angle?

A

Start: the medial and lateral malleoli,
Crossing: metaphyseal portion of the tibia
Angle: away from the join

66
Q

Define Type I salter harris

A

confined to the physis

67
Q

Define Type II salter harris

A

involve a portion of the physis and adjacent metaphysis.

68
Q

Define Type III salter harris

A

involve a portion of the physis and epiphysis

69
Q

Define Type IV salter harris

A

involve the metaphysis, physis, and epiphysis.

70
Q

Define Type V salter harris

A

a compression fracture of the physis without obvious radiographic displacement.

71
Q

Most common salt harris # type?

A

II + I

72
Q

The standard approach to the tibia is:

A

Medial

Fracture Repair 2 (10 decks)

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